Application: Outward Bound / Spirit of Adventure
Date: ……………………………………………….......................
Name: ………………………………………………..........................................................................................................................................................................
Address: ………………………………………………..........................................................................................................................................................................
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Email: ………………………………………………..........................................................................................................................................................................
School: ……………………………………………….........................................................................................................................................................................
Date of Birth ………………………………………………..
Name of Parent / Caregiver: …………………………………................................................................................................................................................................
Phone Number: ………………………………………………
Name of referee who will support your application:
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Phone Number: …………………………................................................
Which programme do you wish to attend?
What do you know about the programme you have selected?
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Why do you wish to attend the programme?
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Do you agree to the following:
To speak to the Kapiti Rotary club after completing the programme
Signed: ……………………………………………………
Completed by Parent/Caregiver:
I support ……………………………………. attending the programme.
Signed: …………………………………………………..